The supraspinatus tendon is part of the rotator cuff, a group of four muscles and their tendons surrounding the shoulder joint. A full-thickness tear means the tendon has completely disrupted, creating a gap through its entire diameter. This injury commonly causes shoulder pain and functional limitations.
Understanding a Supraspinatus Tear
The supraspinatus tendon originates from the shoulder blade (scapula) and attaches to the upper arm bone (humerus). It helps lift the arm away from the body and stabilizes the shoulder joint.
Tears can result from acute injuries, like a fall or lifting something heavy. More frequently, they develop gradually due to age-related wear, repetitive overhead activities, or reduced blood supply.
Individuals with a full-thickness supraspinatus tear often experience pain at rest, especially at night or when lying on the affected shoulder. Pain is also common when lifting or lowering the arm. Other symptoms include weakness when attempting to lift or rotate the arm, and sometimes a crackling sensation (crepitus) during shoulder movements.
Diagnosis typically involves a physical examination to assess range of motion and strength. Imaging studies, such as MRI, confirm the presence and extent of the tear.
Non-Surgical Treatment Options
Several non-surgical approaches are available for managing a full-thickness supraspinatus tear. Initial steps include rest and applying ice to reduce pain and inflammation. Over-the-counter anti-inflammatory medications (NSAIDs) can also help manage discomfort.
Physical therapy is a core component, focusing on restoring range of motion, improving flexibility, and strengthening surrounding muscles. A physical therapist may use manual therapy and prescribe exercises to build strength in the rotator cuff and scapular muscles, aiming to decrease pain and enhance shoulder function.
Corticosteroid injections into the shoulder can provide temporary pain relief by reducing local inflammation. These injections are considered when other conservative measures have not adequately controlled pain. While effective for short-term symptom management, repeated injections may potentially weaken tendon structures.
Factors Guiding Treatment Decisions
Surgery decisions for a full-thickness supraspinatus tear are individualized, considering factors like patient age and activity level. Younger, active individuals with acute traumatic tears may be recommended for surgery, while older individuals or those with lower activity demands might explore non-surgical options.
Tear size and type are important; they vary from small (less than 1 cm) to massive (greater than 5 cm), with larger tears having different implications. Symptom duration also influences the decision; tears present over 6-12 months, especially with significant weakness and functional loss, might lean towards surgical repair.
Pain level and functional impairment are central. Persistent pain significantly interfering with daily activities or sleep may lead to surgery consideration. Other shoulder issues, like osteoarthritis or biceps tendon injury, can complicate treatment. The choice between surgical and non-surgical management is a collaborative decision, weighing benefits and risks against individual circumstances and goals.
Surgical Repair Considerations
Surgery is typically recommended for a full-thickness supraspinatus tear when non-surgical treatments have not provided sufficient pain relief or functional improvement over several months. The primary goal of surgical repair is to reattach the torn tendon to its original insertion point on the humerus bone, closing the gap.
Most supraspinatus tear repairs use arthroscopic techniques, which are minimally invasive. This involves small incisions around the shoulder joint, through which a camera and specialized instruments are inserted. The surgeon visualizes the tear and uses sutures, often secured with small anchors in the bone, to reattach the tendon. This method allows for detailed assessment while minimizing tissue disruption.
Following surgery, an initial recovery phase protects the repaired tendon, typically with immobilization in a sling to allow healing. Physical therapy begins shortly after surgery, focusing on gentle, passive range of motion exercises to prevent stiffness. Progression to active movement, strengthening, and a gradual return to daily activities occurs over several months, guided by a rehabilitation protocol to ensure proper healing and restoration of shoulder function.
Outcomes Without Surgery
If a full-thickness supraspinatus tear is not surgically repaired, several outcomes are possible. Untreated full-thickness tears can enlarge over time. Studies show about half of symptomatic tears progress in size within four years.
Continued pain and weakness are common, limiting daily activities and impacting quality of life. Without proper tendon function, the supraspinatus muscle can atrophy (waste away) and undergo fatty infiltration (muscle tissue replaced by fat). This compromises shoulder function and can make future surgical repair more difficult due to reduced tissue quality and tendon retraction.
For small, isolated tears, non-operative treatment may provide satisfaction, and tear size may not always increase. However, long-term implications of an untreated tear include ongoing pain, reduced range of motion, and decreased capacity for overhead arm movement. The tear may also become irreparable due to significant muscle changes.